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Module 3: Ensuring safe

injections
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
1. Using safe injection equipment and
techniques
2. Preventing needle-stick injuries
3. Disposing of used syringes and
needles

Outline
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
Importance of Vaccine Safety
Decreases in disease risks and increased attention on
vaccine risks
Public confidence in vaccine safety is critical higher
standard of safety is expected of vaccines
vaccinees generally healthy (vs. ill for drugs)
lower risk tolerance = need to search for rare reactions
vaccination universally recommended and mandated
Types of Injection Equipment

3.1 Using safe injection equipment and


techniques
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
Auto-disable (AD) syringes

3.1 Using safe injection equipment and


techniques
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
General Steps in Using AD syringes
1. Remove the syringe from its plastic wrapping
(peel the package open from the syringe plunger
end), or detach the plastic cap.
2. Take off the needle cap without touching the
needle.
3. Insert the needle in the vaccine vial its tip should
be in the lowest part or bottom
of the vial.
3.1 Using safe injection equipment and
techniques
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
General Steps in Using AD syringes
4. Pull the plunger back to fill the syringe just past
the 0.5 ml or 0.1 ml or 0.05 ml mark.
5. Remove the needle from the vial. To remove air
bubbles, hold the syringe upright and tap the barrel.
Then carefully push the plunger to the volume mark.
For the last dose of a multi-dose vial, keep the
needle tip in the fluid at all times, making sure to
empty the full contents of the vial.
3.1 Using safe injection equipment and
techniques
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
General Steps in Using AD syringes
6. Proceed with the injection at the appropriate site
7. Push the plunger forward and inject the vaccine.
At the beginning or just at the end of the
injection, the plunger will automatically lock so
the syringe cannot be reused.
8. Do not recap the needle after use.
9. Dispose of the needle and syringe in a safety box,
which is a leak-proof, puncture resistant
container
3.1 Using for injection
safe sharps waste.
equipment and
techniques
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
Sterilizable syringes and needles

Sterilizable syringes and needles are not


recommended for use in immunization
programmes.

3.1 Using safe injection equipment and


techniques
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
3.1 Using safe injection equipment and
techniques
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
3.1 Using safe injection equipment and
techniques
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
Simple ways to improve injection safety

Prepare injections in a clean, designated area that


is free from blood and body fluid contamination.
Prepare each dose immediately before its
administration do not prepare several syringes
in advance.
Never leave the needle in the top of the vaccine
vial.
3.1 Using safe injection equipment and
techniques
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
Simple ways to improve injection safety
Follow product-specific recommendations for storage,
handling and use of vaccines.
Follow safe procedures to reconstitute
vaccines. The correct diluent must be used for
reconstituting freeze-dried vaccines.
Use only the diluent supplied by the
manufacturer for each vaccine check then
labels.
Diluents
3.1 Using must
safe be cooled equipment
injection before reconstitution.
and
techniques
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
Simple ways to improve injection safety

Dispose of used AD and RUP needles and syringes in a


safety box.
Follow national multi-dose vial policy for opened vials.
Use a new AD needle and syringe for every child:
Inspect the packaging very carefully.
Discard the needle and syringe if the package has been
punctured, torn or damaged in any way.
Do not touch any part of the needle.
3.1 Using safe injection equipment and
techniques
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
Simple ways to improve injection safety

Discard a needle that has touched any non-sterile


surface.
Position the child carefully to minimize risk of
movement and injury.
3.1 Using safe injection equipment and
techniques
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
Minimizing the need to handle needles and syringes

Place a safety box close to the person giving vaccinations so


used needles and syringes can be disposed of immediately,
easily and without walking to find a sharps container.

Avoid recapping the needle. If recapping is absolutely


necessary for example, if the injection is delayed because
the child is too agitated use the one-hand technique of
placing the cap on a table or tray and reinserting the needle
by sliding it inside without using the other hand.

3.2 Preventing needle-stick injuries


Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
Minimizing the need to handle needles and syringes

Do not remove the used needle from the syringe with your
hands.
Do not carry used syringes and needles around the work
site for any reason.
When ready to administer, draw the vaccine into the
syringe, give the injection and dispose of the syringe in the
safety box without putting it down between steps.
Close the safety box securely when it is three quarters full.
Do not manually sort needles and syringes.

3.2 Preventing needle-stick injuries


Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
3.2 Preventing needle-stick injuries
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
3.2 Preventing needle-stick injuries
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
Setting up the immunization work area to
minimize risk of injury

The vaccinator (person giving doses of vaccine) should


be between the child and all needles and sharp objects.
The vaccinator should be able to see the opening of the
safety box when discarding needles. The safety box may
be on a table or the floor depending on whether the
vaccinator is standing or sitting. He or she should be
able to reach it easily and without much change in
position.

3.2 Preventing needle-stick injuries


Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
Setting up the immunization work area to
minimize risk of injury
The vaccinator should be able to dispose of used needles
and syringes directly in the safety box without putting them
down on other surfaces.
The vaccinator should have only one child with
caregiver(s) at a time in their workspace.
Each vaccinator should have a separate safety box,
especially at busy sites.
The vaccine carrier should be in the shade.
Tally sheets should be within easy reach.
3.2 Preventing needle-stick injuries
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
Why is it important to handle sharps waste
properly?

Dangers to health
Dangers to the environment

3.3 Disposing of used syringes and needles


Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
Safety boxes

3.3 Disposing of used syringes and needles


Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
How to assemble
a safety box

3.3 Disposing of used syringes and needles


Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
What to do if safety boxes are not
available

strong cardboard boxes,


metal cans or
thick plastic containers

3.3 Disposing of used syringes and


needles
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
How to create a good sharps container if a safety
box is not available
Find a strong cardboard box (a local shop may have some).
Ideally, the walls of the box should be strong enough to keep
needles from piercing through and causing needle-stick
injuries.
If needed, place one box inside another to create a stronger
container that can prevent needles piercing through.

3.3 Disposing of used syringes and


needles
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
How to create a good sharps container if a safety
box is not available
Close the box securely on the top and bottom seal it with
strong adhesive tape or similar material.
Cut a small hole in the top it should be just big enough for
a needle and syringe to enter (maximum 38 mm).
When the box is three quarters full, seal the opening.
Dispose of the box properly

3.3 Disposing of used syringes and


needles
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
3.3 Disposing of used syringes and
needles
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
Disposing of filled safety boxes

3.3 Disposing of used syringes and


needles
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
Disposing of filled safety boxes

3.3 Disposing of used syringes and


needles
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
Disposing of filled safety boxes

3.3 Disposing of used syringes and


needles
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
Disposing of filled safety boxes

3.3 Disposing of used syringes and


needles
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
3.3 Disposing of used syringes and
needles
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
3.3 Disposing of used syringes and
needles
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
3.3 Disposing of used syringes and
needles
Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
The Providers Role
Immunization providers can help to ensure the safety and
efficacy of vaccines through proper: vaccine storage and
administration
timing and spacing of vaccine doses
observation of contraindications and precautions
management of adverse reactions
reporting AEFI
benefit and risk communication